Depressive Disorder, Violence
Conditions
Keywords
depression, violence, emergency department, mhealth, text message
Brief summary
The purpose of this investigation is to test the efficacy of "iDOVE2" (a brief emergency department introductory session and longitudinal automated text-message depression prevention program for high-risk teens), and to determine the most potent and parsimonious combination of intervention components for preventing peer violence and depressive symptoms among at-risk youth.
Detailed description
Peer violence and depressive symptoms have mutual, reinforcing negative impacts on teens' emotional and behavioral regulation strategies. The emergency department (ED) is the primary source of care for many high-risk teens. It provides an opportunity to initiate preventive interventions, to complement existing mental health treatment or to stand alone for those who may lack access to formal care. Personalized text-message interventions are accessible, feasible, and may be effective with these adolescents. The purpose of this study is to expand on the PI's pilot randomized controlled trial (RCT) of iDOVE (K23 MH095866; PI: Ranney) by testing the efficacy of "iDOVE2" (a brief emergency department introductory session and longitudinal automated text-message depression prevention program for high-risk teens). The investigators will use a 2x2 factorial design to determine the most potent and parsimonious combination of intervention components for preventing peer violence and depressive symptoms among at-risk youth. Participants will be identified in the course of usual clinical care in the ED. If eligible, parents will be consented and participants assented. Participants will complete a baseline assessment and will be randomized to one of four groups: Brief ED Intervention (BI) + Text; BI + No Text; No BI + Text; or No BI + No Text. Youth in the Text arm who show no signal of improvement at 7 days, per daily self-reported mood ratings, will be re-randomized to additional "LiveText" (once-weekly real-time micro-counseling via text) or to continue with standard, automated Text intervention curriculum. At baseline and follow-ups at 2 months, 4 months, and 8 months, participants will complete assessments on depressive symptoms, violence, cognitive/behavioral skill-sets, and resource utilization.
Interventions
BEHAVIORAL+ Brief ED Intervention (BI)
Brief ED Intervention (BI): A 20-minute Motivational Interviewing- and Cognitive Behavioral Therapy-based in-Emergency Department session delivered by a bachelors'-level Research Assistant
BEHAVIORAL+ Text
Text: 8 weeks of an automated, tailored, two-way text-message curriculum started after the ED visit, which reinforces cognitive reappraisal, emotional regulation, and self-efficacy skills. Those that do not show improvement in mood after 7 days will be randomized into LiveText.
Sponsors
Rhode Island Hospital
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
13 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* English-speaking * presenting to the emergency department for routine care * reporting past-year physical violence (using a modified version of The Revised Conflict Tactics Scales (CTS-2) score ≥1), as identified on a brief screen administered in the ED * reporting past 2-week mild-to-moderate depressive symptoms (using Patient Health Questionnaire (PHQ-9) score 5-19), as identified on a brief screen administered in the ED * Accompanied by a parent/guardian who is present and able to consent * Possession of a cell phone with text-messaging capability
Exclusion criteria
* Chief complaint of suicidality, psychosis, sexual assault, or child abuse * In police or child protective services' custody (as per state law) * Unable to assent * In need of emergency psychiatric care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Conflict Tactics Scale-2, physical subset (CTS-2) | Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment | Change from enrollment physical peer violence (score is summed, range 0 - 56) |
| Center for Epidemiologic Studies Depression Scale Revised (CESD-R) | Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment | Change from enrollment depressive symptoms (score is summed based on symptom group, range 0 - 80) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in ED Visits for Assault-Related Injury | 12 months before enrollment and 12 months after enrollment | Review of hospital system-wide Electronic Medical Record and state-wide Health Information Exchange to identify ED visits for peer assault |
| Conflict in Adolescent Dating Relationships Inventory, physical subset (CADRI) | Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment | Change from enrollment other forms of peer violence (dating relationships) |
| Illinois Bully Scale (IBS) | Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment | Change from enrollment other forms of peer violence (bullying) |
| Student School Survey | Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment | Change from enrollment other forms of peer violence (bullying) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMegan L Ranney, MD MPH
Yale School of Public Health
Outcome results
None listed